There have been a number of complaints, reports, and legislative and state health board filings surrounding Dental Service Organizations, or DSO’s over the past few years. So, why is that and what do these organizations do that opens the door to bad practices?
What are Dental Service Organizations
First, let’s just go over the basics to get a better understanding of the way these groups are set up. Dental Service Organizations, or Dental Support Organizations, are corporations that aid Dentists and practices by providing business management services. This can come in the form of the DSO handling all staffing, marketing, finance and even owning the physical location and equipment of the practice. Or, it can just act as a management group for some support.
In some cases, the DSO is run and/or funded by investment firms.
All in all, the idea isn’t a bad one. Some Dentists don’t want to have to run every aspect of their practices. They got into Dentistry to help people and anything that distracts them from providing good oral health can be just that, a distraction. Most dental schools don’t teach business management. Students have enough to worry about with their existing course load, and taking extra business classes just isn’t an option for them. Therefore, Dentists should have the option of running their own practice or inviting help.
It comes down to purpose.
In essence, the idea of a DSO sounds great and has the potential to be a great service in Dentistry. However, we run into a problem when we get into the subject of purpose and philosophy.
A dental practice is a business, granted. However, the overall purpose for most Dentists is going to be along the lines of helping their patient. The purpose of a management group is generally going to have something to do with making money and creating a profitable business. This isn’t an evil idea or wrong. It’s merely a difference. However, there has been a problem in the U.S. resulting from the mix of profit and healthcare.
This issue becomes most apparent when the mixing of purposes starts to affect patient care. Your Dentist is going to do what he or she needs to do in order to ensure your oral health is in good standing. They need to have full autonomy in that area in order to use their years of training to help their patient. Sometimes their decision might not be profitable, but it’s what their patient needs. Maybe they can’t fully handle a problem and have to send a patient to a specialist. Maybe they need expensive equipment, or maybe they want to pay more for a faster lab. In each case, this is the Dentist’s choice and it’s intended to increase the level of care for patients.
How can this affect you?
The effect is really going to depend on the dental practice you choose. Some Dental Service Organizations have learned how to maximize profit without inhibiting their dentists and deteriorating care. Unfortunately, others have earned the institution a terrible name by focusing on money alone.
Most states have begun to pass laws limiting the reach of DSO’s as a result of numerous complaints from state dental associations and the American Dental Association. Unfortunately, some organizations still find ways around these laws. Basically put, the regulations and laws state that clinical care is entirely at the discretion of the Doctor. Dental Service Organizations are not allowed to own a practice or dictate anything that affects the clinical aspect of a practice.
There are loopholes that DSO’s have found. Documented cases include setting quotas for material for denture fittings, telling Dentists what equipment they can and can’t buy, colluding with staff to reuse single-use mouthpieces, and telling staff not to refer patients to other practices. This has gotten so bad that one DSO was fined over $20M and sanctioned after counts of Medicaid Fraud and unethical treatment of children.
There are many cases proving that DSO’s will increase patient quotas so high that Dentists and Hygienists don’t have enough time properly evaluate problems and prescribe treatment. Instead, patients get the minimum and possibly live with problems that are easily fixed. So, groups have found a way of inadvertently decreasing the level of care in the interest of making more money.
To top it off, we recently spoke to a former state dental board Examiner and were told that the number of complaints against the DSO’s in their state had risen to the point where it was nearly impossible for the board members to follow up with each of them.
The possible effect on you:
- Decreased ability to truly care for patients
- Cheaper equipment and materials
- Risk of infection
- Unhappy staff
What are your options?
Again, it comes down to each practice and management group. Do your homework and get to know a Dentist before trusting them with your oral health. This isn’t a blanket rule, but it appears that private practicing Dentists have a better chance of providing the care you need. In private practice, everything is owned by the Dentist and all decisions will be up to him or her. In this situation, you’ll at least know that business decisions are going to be made by someone whose main purpose is to help you.
There are no absolutes with Dental Service Organizations or private practicing Dentists, but it’s worth your research and evaluation.
If you’re curious about private Dentists in your area you can always check our Member Directory.